Cutbush C M, McDonough J P, Clark K, McCarthy E J
1st Medical Group, Langley Air Force Base, VA, USA.
CRNA. 1998 Aug;9(3):106-12.
A number of studies have shown conflicting results on the effect of epidural (EPI) analgesia on the length of labor. Combined spinal-epidural (CSE) and intrathecal analgesia (ITA) techniques have been used to provide pain relief for parturients, but currently there are few studies comparing EPI, CSE, and ITA techniques and their effect on the length of labor. Intrathecal opioids provide immediate pain relief for the parturient without autonomic, sensory, or motor blockade. The purpose of this retrospective study is to identify the effects of ITA on the length of labor compared with other regional anesthesia techniques. A total of 213 uncomplicated obstetric charts were reviewed in a 70-bed Air Force hospital that provided EPI, CSE, and ITA for obstetrical patients. The study consisted of the following four groups: (1) CSE (n = 76), (2) EPI(n = 41), (3) ITA (n = 49), and (4) no regional analgesia (NR) (n = 47). The results showed that the length of first-stage labor was statistically significantly less for those who received ITA compared with those who received CSE, EPI, and NR (P < .001). Second-stage labor was statistically significantly shorter for the NR group compared with the CSE and EPI groups (P < .01). No statistically significant difference was found between the length of second stage for ITA and NR groups. ITA analgesia shortened the first stage significantly in both primipara and multipara patients (P < .01). These results imply that the use of intrathecal opioids in the obstetrical patient does not prolong labor and seems to shorten the first stage of labor in both the primipara and multipara patients.
多项研究在硬膜外（EPI）镇痛对产程时长的影响方面得出了相互矛盾的结果。腰麻-硬膜外联合（CSE）和鞘内镇痛（ITA）技术已被用于为产妇提供疼痛缓解，但目前比较EPI、CSE和ITA技术及其对产程时长影响的研究较少。鞘内使用阿片类药物可立即为产妇缓解疼痛，且不会产生自主神经、感觉或运动阻滞。这项回顾性研究的目的是确定与其他区域麻醉技术相比，ITA对产程时长的影响。在一家拥有70张床位的空军医院，对213份无并发症的产科病历进行了回顾，该医院为产科患者提供EPI、CSE和ITA。该研究包括以下四组：（1）CSE（n = 76），（2）EPI（n = 41），（3）ITA（n = 49），以及（4）无区域镇痛（NR）（n = 47）。结果显示，与接受CSE、EPI和NR的产妇相比，接受ITA的产妇第一产程时长在统计学上显著更短（P < .001）。与CSE和EPI组相比，NR组的第二产程在统计学上显著更短（P < .01）。ITA组和NR组之间的第二产程时长未发现统计学上的显著差异。ITA镇痛在初产妇和经产妇中均显著缩短了第一产程（P < .01）。这些结果表明，在产科患者中使用鞘内阿片类药物不会延长产程，而且似乎会缩短初产妇和经产妇的第一产程。
